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Eligibility

Inclusion Criteria

Primary isolated CABG patients with disease of the left main coronary artery or of the left anterior descending and the circumflex coronary system with or without disease of the right coronary artery.

Coronary artery disease will be defined as a stenosis ≥ 70% based on coronary angiography, a FFR value ≤ 0.80 or iFr value ≤0.89; a left main diameter stenosis ≥ 50%, left main IVUS MLA value ≤ 4.5 mm2, or equivalent OCT measurements will also be considered.

Exclusion Criteria

Age >70 years

Planned single graft

Emergency operation

Preoperative myocardial infarction within 48 hours

Ejection Fraction (EF) < 35%

Any concomitant cardiac or non-cardiac procedure

Previous cardiac operation

Planned hybrid revascularization

Preoperative severe end-organ dysfunction (dialysis, liver failure, respiratory failure), cancer or any co-morbidity that reduces life expectancy to less than 5 years

Inability to use either the saphenous vein or both the right ITA and the RA as grafts